If holding OPITO approved course certificate or refresher certificate fill in the data

Course name :

Certificate number:

Date of expiry:

Vantage Number:

Note: please check for extension to an expired certificate as/ if applicable. Where an extension is granted,
the effective start date of the new refresher training certificate will be the expiry date of the individual's
corresponding, current certificate. Refer OPITO international ER guidelines - to apply for dispensation,
please fill request for dispensation form.